Augmented Mental Health

The mental health insurance revolution is nigh. Research and industry projections suggest that smart mHealth solutions can help solve the mental health insurance crisis as the world grapples with rapidly rising rates ofdrug addiction, mental illness, and suicide, raising the demand formental health insurance and comprehensive caremore than ever before.

The mental health insurance market is crying for change that meets new demands. In the US alone, over7.5 million adults with a mental illness remain uninsureddespite the demand. And unfortunately, even having insurance coverage does not equate to treatment access. The majority of USadults (56.5%) with a mental illness received no past year treatment, and for those seeking treatment,1 out of 5people continue to report they are not able to get the treatment they need.

This pattern is not unique to the US. When it comes to mental health, there are genuine problems that are keeping insurance providers and employersfrom delivering mental health insurance coveragethat is up to par with general health coverage. Likewise, these problems are alsostopping mental health providers from joining and expanding the network, and patients from seeking them out.

Around the globe,health insurance giants are changing the way that insurance coverage worksby providing unique health insurance programs that integrate mHealth platforms into their insurance plans, like UnitedHealthcare’s wellness program Motion. These smart mHealth platforms couple smart wearables like the Fitbit or Apple Watch with mobile health (mHealth) smartphone applications to monitor physical health and fitness, and improve it!

Already invaluably improving health insurance coverage when it comes to physical health,smart mHealth platforms are a comprehensive solutionto issues that arestagnating the evolution of mental health insurance coverageand the growth of the mental health insurance industry.

In the US, the Affordable Care Act (ACA) was the kindling that sparked radical change in the mental health insurance market.Smart mHealth tech is the revolutionary that could set this change on fire!

Benefits of Smart mHealth for Objective Mental Health Monitoring & Risk Assessment​There have been phenomenal advances in theaccuracy and reliabilityof objectively assessing emotions, mental health, and wellbeing using real-time data from smartphone use and biosensors in wearable tech, particularly in predicting clinical outcomes. For example, a mHealth device was recently used to detect the autonomic signature of illness severity in schizophrenia from heart rate variability, electrodermal activity, and movement data — clearly invaluable to the calculation of risk in this population.

1) Improved mental health screeningFailure to recognize and appropriately treat mental health conditions has a huge impact on both physical and mental health outcomes, where costs with hospitalization are more likely and re-admittance more frequent. The American Psychiatric Association (APA) estimated that costs are 2.5–3.5 times higher for patients with co-morbid mental health or substance abuse problems.

The 2017 APA report on the economic impact of integrated medical-behavioral healthcare revealsa total annual value opportunity of $162 billion in the commercial US market and $38 million in the Medicaid marketthrough integration, where the highest portion of total value opportunity comes from effectively attending to mental health comorbidities.

Smart mHealth solutions can be used toidentify mental health and wellness problems, conditions, and comorbidities soonerand as they emerge, allowing for earlier intervention and lowering of risk. Just as Stanford Medicine are screening for irregular heart rhythms (an often overlooked sign of serious illness) with the Apple Watch,smart mHealth platforms for mental health could identify and mitigate against the early warning signs of mood and anxiety disorders.

2) Determining treatment efficacyInsights into treatment efficacy hold the promise of achieving better treatment outcomes thatlower risks and equate to cost savings.Treatment efficacy insights are valuable for insurers, as well as insurance providers, payers, and consumers. As demonstrate in the general health space, Valedo® is a smart mHealth system that monitors progress with physical therapy training and shares the results with the therapist.

3) A reference point to improve mental health and reduce riskThe assessment of mental healthand risk with technology also comes with the power to provide a platform that can be used to improve the user’s health status, identify problems, and drive down this risk by promoting behavior change.Theobjective and real-timenature of using wearable technology provides particular benefits for mental health assessment, that still largely relies on traditional subjective endpoints from non-real-world evaluations.

Mitigating risk through incentivizing behavior change, ranging from lifestyle modification and preventive care to disease management, is the basis of the smart mHealth platforms currently being used for physical health insurance.

Another crowning achievement of such platforms is that patients don’t have to wait to receive treatment, they can remotely receive and improve upon their treatment exactly when it is needed. Whether an AI or chatbot delivers ajust-in-time interventionfor a panic attack sufferer (known as ecological momentary intervention or EMI) ordelivers an assessment of the necessity for an emergency telehealth interventionfrom a real-life health professional, mobile provision of treatment comes with awhole host of benefits:

1)Improved access to mental health treatmentEven if a patient has insurance, access to in-network psychiatrists and mental health professionals is below substandard.

For instance, Washington state should arguably have one of the best networks in the US,yet the latest research concluded that the majority of network psychiatrists were unreachable or unable to schedule new appointments.Reported average wait times of 19 days and only 14% of callers able to make an appointment is simply not acceptable. At the least, it increases the risk of further declines in mental health and the need for more intensive treatment, and at worst is potentially devastating for a suicidal patient.

Washington is not an exception;the barriers to evidence-based treatment are essentially a global problem, and smart mHealth offers a promising way of overcoming these barriers.

2) Improved treatment and relapse preventionKey to relapse prevention, multiple lines of evidence showpatients are less likely to discontinue therapy when using mHealth apps and wearables to monitor their mental or physical health. Treatment efficacy can also be improved. For example, a recentmeta‐analysis of 18 randomized controlled trialsrevealed that smartphone app-based mental healthinterventions were significantly better at reducing symptomsof depression in individuals with primary depression, comorbid depression, and subclinical depressive symptoms than controls (no app or use of a general app not designed for mental health improvement).Many companies are already using old-gen apps (not combined with wearables) to engage patients in exercises designed to improve their conditions, primarily derived from cognitive behavioral therapy (CBT), mindfulness, and other clinically validated practices. Meta-analyses of these smartphone delivered assessments and interventions highlight efficacy in the treatment of psychotic disorders, and improvement of many clinical outcomes and aspects related to mental health, such as anxiety, depression, perceived stress, and positive psychology.

3) Early detection and interventionOne unique benefit objectively detecting mental health risk with biosensors and other smart device data is the unmatched timely delivery of support through smartphones when the patient needs it, not weeks after calling when the crisis point may have already been reached and breached.

Analysis of real-time data can detect when potentially problematic changes to psychological well-being and mental health are detected; device-delivered assessments can be used to see if an intervention is needed; and device-delivered interventions can be used to serve that need between scheduled visits — all out-of-clinic.​A fitting example is the use of a smartwatch coupled with app-based delivery of just-in-time CBT-based interventions to prevent stressful episodes in armed forces veterans undergoing CBT. The platform successfully augmented therapist-delivered CBT, resulting in continued adherence to therapy, and reduced stress, anxiety, and anger when compared to controls undergoing CBT without using the platform.

The ImpactAll of the benefits of employing smart mHealth platforms are fuel for the mental health insurance market to growand meet ever-pressing demands for high quality, affordable, in-network mental health insurance and care:

From an insurer’s and payer’s perspective, smart mHealth solutions are also attractive as they hold the potentialto dramatically drive down the high cost, loss of productivity, and time involved in mental healthcare(claims for disability, for lapses, and full-blown relapse).

From a provider’s perspective, this boils down to higher reimbursement rates that support network growth by encouraging mental health practitioners to join, as well as cost savings for the health plan, and more comprehensive plans to offer their patients.All of which is important for growth of the mental health insurance network and desire of patients to seek in-network mental health specialists.

Research shows some of the biggest dissuades preventing the majority of mental healthcare providers joining a network is the low fees and unacceptable limits on the receipt of care.Smart mHealth platforms can be used to lift these limits, a further incentive for mental health insurance network growth.​

Providing an opportunity for mental and behavioral health providers to enter the larger health system also helps satisfy the ongoing need for the integration of general and mental health domains andeffective population health management.

In Sum: Ultimately, such innovative solutions are priceless in addressing the ever-pressing demand for high quality, affordable, in-network mental health insurance and care. With benefits for insurers, providers, payers, and consumers, smart mHealth is a WIN, WIN, WIN, and WIN for mental healthcare.